Scope of practice bill, Montana HB 929, tabled in Senate

The Montana Senate has tabled House Bill 929 (Montana HB 929), which seeks to expand scope of practice for chiropractic practitioners in the state.

The bill, introduced by Rep. Greg Oblander (R-Billings) on March 31 after the defeat of scope-expansion bill HB 500, passed its third reading on April 5 with a vote of 54-44 and was transmitted to the Montana Senate for consideration. The Senate heard testimony from Oblander and others on April 11. Then on April 15, the Senate Business, Labor and Economic Affairs Committee tabled the controversial measure. On April 25, a motion was made to take it from the table, but the vote was tied.

Montana HB 929 proposes expanding DCs’ state-licensed scope of practice, including giving DCs the option of applying for a prescriptive license endorsement that would allow them to prescribe and administer certain medications. The medications within their scope would include muscle relaxants, over-the-counter analgesics, prescription NSAIDs, topical analgesics and anti-inflammatories, and oral and topical corticosteroids. The bill leaves the door open for the board in charge of chiropractic to add new drugs to this list in the future.  In order to be granted prescriptive authority, DCs would have to complete required education, which has not yet been specified.

The bill also updates the legal definition of chiropractic to go beyond only addressing spinal conditions, and grants DCs the right to use the term “doctor” and prefix “Dr.,”  as long as they do not use it to imply they are medical doctors.

House Bill 929’s introduction follows the double defeat of Montana House Bill 500, which was voted down in its third reading by a 48-50 vote on March 5. On March 6, Rep. Oblander moved to have the bill reconsidered and it was restored to its third reading status by a vote of 54-44, but HB 500 was again defeated on March 7 by the margin of a single vote, 49-50. With a general transmittal deadline of March 12, time ran out for any further action on the legislation.

Rationale for prescriptive authority

Montana HB 929 notes several reasons behind the movement toward allowing DCs to prescribe. First, it cites a statewide physician shortage that leaves many medical doctors unable to keep up with patient demand for services. Several other bills in progress also have this physician shortage propelling them, including those that would extend interstate licensing for psychologists, respiratory therapists and physician assistants, allow certain procedures to be performed by aides and assistants, authorize PAs and physical therapists to handle workers’ compensation cases, and more.

Extending DCs limited prescribing authority would also save patients the time, hassle and expense of having to go to an MD for medication for conditions their DC is already handling. Finally, the bill notes that the limited drugs covered by this plan are not controlled substances and are not addictive or harmful. The prescriptive endorsement would be an option for DCs who want it, not a state requirement.

Currently, in most states, DCs have no prescriptive authority, but in New Mexico DCs who obtain further certification and register with the state as “advanced practice” DCs (with the credential AP-C) gain limited prescribing capability. Among the drugs they are approved to prescribe and administer are certain oral, sublingual and topical hormones, certain injectable items like epinephrine, prescription-strength NSAIDs, muscle relaxers, topical lidocaine and certain prescription-level homeopathics.

Opposition to Montana HB 929

Many DCs oppose this bill due to its provision for limited prescriptive authority, arguing that pharmaceuticals do not have a place in chiropractic care, which has always relied on natural means as well as the body’s innate healing abilities to improve patients’ health and well-being. On April 11, several Montana DCs turned out to speak against the bill, which is also opposed by several national and state organizations, including the Georgia Council of Chiropractic and the Montana Medical Association.

The International Chiropractors Association (ICA), which opposed HB 500, also opposes HB 929. ICA officials have stated they oppose the bill because it takes the practice of chiropractic in a direction counter to its founding principles.

“All but a tiny fringe element of the profession desire to keep chiropractic a non-prescribing profession,” noted ICA executive director Beth Clay in a March 31 post on the ICA’s blog. “Montana health professionals and their patients would be better served by expanding the opportunity of Telehealth and professional collaboration in real time between chiropractors and medical doctors rather than expanding the scope of chiropractic to include drug prescribing.”

A follow-up post on April 5 notes the ICA will continue to urge state senators to reject Montana HB 929. A fact sheet on the ICA’s website further explains its reasons for opposing HB 929.

Scope expansion efforts elsewhere